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  Date: 2023-05-22
  Time: 17:35
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<%@ page contentType="text/html;charset=UTF-8" language="java" %>
<!doctype html>
<html lang="zh-CN">
<head>
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
    <title>预约检查 - 医院名</title>
    <link rel="stylesheet" href="https://cdn.staticfile.org/font-awesome/5.15.3/css/all.min.css">
    <link rel="stylesheet" href="https://cdn.staticfile.org/bootstrap/5.0.1/css/bootstrap.min.css">
    <jsp:include page="include/mangerheadtag.jsp"/>
</head>

<body class="bg-light">
<jsp:include page="include/head.jsp"/>
<jsp:include page="include/menu.jsp"/>
<div class="container py-5" style="margin-left: 300px;margin-top: 100px">
    <h1 class="text-center mb-4"><img src="images/检查.png">预约检查</h1>
    <form method="post" action="<%=request.getContextPath()%>/checkServlet">
        <input type="hidden" name="action" value="getInformation">
        <div class="row">
            <div class="col-md-6 mb-3">
                <label for="inputName" class="form-label">患者姓名</label>
                <input type="text" class="form-control" id="inputName" name="name" required>
            </div>
            <div class="col-md-6 mb-3">
                <label for="inputGender" class="form-label">患者性别</label>
                <select class="form-select" id="inputGender" name="sex" required>
                    <option value="">请选择</option>
                    <option value="男">男</option>
                    <option value="女">女</option>
                </select>
            </div>
        </div>

        <div class="row">
            <div class="col-md-6 mb-3">
                <label for="inputAge" class="form-label">患者年龄</label>
                <input type="number" class="form-control" id="inputAge" name="age" required>
            </div>
            <div class="col-md-6 mb-3">
                <label for="inputPhone" class="form-label">联系电话</label>
                <input type="tel" class="form-control" id="inputPhone" name="phonenumber" required>
            </div>
        </div>

        <div class="mb-3">
            <label for="inputIDNumber" class="form-label">身份证号码</label>
            <input type="text" class="form-control" id="inputIDNumber" name="IdNumber" required>
        </div>

        <div class="row">
            <div class="col-md-6 mb-3">
                <label for="inputDepartment" class="form-label">检查科室</label>
                <select class="form-select" id="inputDepartment" name="department" required>
                    <option value="">请选择</option>
                    <option value="内科">内科</option>
                    <option value="外科">外科</option>
                    <option value="妇产科">妇产科</option>
                    <option value="儿科">儿科</option>
                    <option value="眼科" >眼科</option>
                    <option value="口腔科">口腔科</option>
                    <option value="皮肤科">皮肤科</option>
                    <option value="传染病科">传染病科</option>
                    <option value="精神科">精神科</option>
                    <option value="影像科">影像科</option>
                    <option value="麻醉科" >麻醉科</option>
                </select>
            </div>
            <div class="col-md-6 mb-3">
                <label for="inputTime" class="form-label">预约时间</label>
                <input type="time" class="form-control" id="inputTime" name="time" required>
            </div>
        </div>
        <button class="w-100 btn btn-lg btn-primary" type="submit">提交预约</button>
    </form>
</div>

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</body>
</html>
